| Abstrakt: |
Background: Melody valve endocarditis is a complication during a follow-up in patients after right ventricular outflow tract reparation. It is most frequent in the first three years after transcatheter pulmonary valve implantation. Aim: I present a case of a young male person with a history of tetralogy of Fallot diagnosed with staphylococcal infectious endocarditis and, as a result, a necessary cardiosurgical reintervention. Case Report: A 17-year-old boy was admitted to the hospital for suspected infective endocarditis. He has a medical history of Tetralogy of Fallot and the installation of the Melody valve in 2021. When he was admitted to the hospital, he had a high fever, a dry cough, and could not tolerate exertion. He also had elevated inflammatory parameters: CRP 306, L 12.5 with neutrophilia, NT-pro-BNP 4052. Ceftriaxone, flucloxacillin, and oseltamivir were initially introduced into the therapy. Staphylococcus aureus was isolated from the blood culture; therefore ceftriaxone was discontinued, and gentamicin was introduced into the therapy. Oseltamivir was also discontinued from therapy after the flu was ruled out. Echosonography showed an enlarged right ventricle and turbulent flow through the Melody valve with stenosis and a slightly thickened valve. Vegetation could not be shown. CT pulmonary angiography showed condensations of the lung parenchyma of both lung wings with bilateral pleural effusions. Given the continuous febrility and a large number of positive blood cultures, a diagnosis of Melody valve endocarditis was made. At the consultation, the extirpation of the stent and melody valve from the right ventricular outflow tract was recommended, as well as the implantation of an aortic homograft between the right ventricle and the pulmonary valve. Conclusion: Although the risk of infectious endocarditis of a Melody valve is significant, diagnosis is still very challenging. Approximately half of the patients require reintervention. [ABSTRACT FROM AUTHOR] |
